Contributed by: Miloslav Klugar

Background

One-day surgery was identified as a public health topic within the national Clinical Practice Guidelines project by the Guarantor Committee (representatives of important policymakers in the Czech Republic from the Ministry of Health, Institute of Health Information and Statistics, Czech Health Research Council, and health insurance organizations). One-day surgery has various definitions in different health systems worldwide; the definition for the Czech health system agreed by guideline panellists is “surgical performance (diagnostic and therapeutic) for hospitalization not exceeding 1 day (up to 24 hours of hospitalization, including one overnight stay).” In the Czech Republic, there are several surgical procedures in some hospitals in the 1-day surgery regime, while in other hospitals patients may be routinely hospitalized for the same surgical procedures for 3-6 days. One-day surgery clearly involves surgeons as a key audience, but also health care users, health care providers, and policymakers. In addition, following GRADE guidance, it was clear that social work and community care stakeholders needed to be engaged, as timely discharge from hospital and patient safety following discharge depend on social and community care.

Examples of challenges

Challenge 1: Initially the guideline panel membership included only surgeons and methodologists and the focus was on identifying which surgical procedures should be covered by 1-day surgery. There was initial resistance to inviting allied health professionals, patients, and other relevant stakeholders to join the panel. Furthermore, after framing the guideline questions the panel realized that social work/community care stakeholders should also be on the panel and that representation was needed from health and social insurance organizations, as well as homecare organizations. Identifying representatives from different organizations/sectors and managing the work of such a diverse guideline panel presented a challenge.

Challenge 2: Although the Population, Intervention, Comparison, Outcome format is straightforward in its application to public health questions, the panel faced a challenge in prioritizing clinical versus social and community care outcomes, particularly in terms of the identification and management of postsurgical complications and patient safety after discharge from hospital.